Tension Headache

Tension headaches are the most common kind of headaches. They cause aching, tightness, pressure, and pain around the forehead, temples, or back of the head and neck. They tend to happen again and again, especially if you are under stress. They usually aren't a sign of something serious. But they can be very painful.


Tension-type headache: Areas of pain

Possible areas of pain with tension headache

Tension headaches can cause pain:

  • In your upper back and neck.
  • At the base of your head.
  • Around your ears.
  • In your jaw.
  • Above your eyes.

What are the symptoms of a tension headache?

Symptoms of tension headaches include:

  • A constant headache that doesn't throb or pulse. The pain or pressure is usually on both sides of the head.
  • Tightness around the forehead that may feel like a "vise grip."
  • Aching pain at the temples or the back of the head and neck.

Unlike migraines, tension headaches usually don't occur with nausea, vomiting, or feeling sensitive to both light and noise. But light or noise could make the headache worse. Pain from a tension headache usually isn't severe and doesn't get in the way of a person's school, work, or social life. But for some people, the pain is very bad or lasts a long time.


What causes tension headaches?

The cause of tension headaches isn't clear. In the past, doctors believed that tension or spasms of the muscles of the neck, face, jaw, head, or scalp played a role in causing these headaches. Now they think a change in brain chemistry may also help cause them.

Tension headaches can be brought on—or triggered—by things such as stress, hunger, being tired, and not sleeping enough. They may come on suddenly or slowly.

Chronic tension headaches are headaches that keep coming back. They can occur along with other health problems such as anxiety or depression.


How can you prevent tension headaches?

Here are some things you can try to help prevent tension headaches.

  • Keep a headache diary. This can help you and your doctor figure out what is triggering your headaches. If you can avoid your triggers, you may be able to prevent headaches.
  • Find healthy ways to deal with stress. Headaches are most common during or right after stressful times.
  • Get plenty of exercise every day. This can help with stress and muscle tension.
  • Get regular sleep.
  • Eat healthy foods. Try to eat regularly. If you wait too long to eat, it can trigger a headache.
  • Try to use good posture and keep the muscles of your jaw, face, neck, and shoulders relaxed.
  • If you use a computer a lot, give your eyes a break by blinking more and sometimes looking away from the screen. Use glasses or contacts if you need them. And check that your monitor is about an arm's distance away.


How are tension headaches diagnosed?

A doctor can usually diagnose tension headaches by doing a physical exam and asking questions, such as how often the headaches happen and what the symptoms are. The doctor will also ask about your overall health and lifestyle.

It can be hard to know which type of headache you have. That's because different types can have the same symptoms. But the treatments may be different, so it's important to find out which type you have.

In some cases, your doctor may order tests to find out if a health problem is causing them. These tests may include an MRI or a CT scan.

In very rare cases, headaches can be caused by more serious health problems (such as brain tumors or aneurysms). But most headaches aren't caused by anything serious. So you probably won't need to have tests.


How are medicines used to treat tension headaches?

Your doctor may recommend medicine to stop or to prevent tension headaches.

The type of tension headache you have may help your doctor decide which drug to prescribe. You may have to try several different drugs or types of drugs before you find the one that is right for you. Make sure to tell your doctor how well a drug stops your headaches.

You might need to take only an over-the-counter medicine for pain. They usually have fewer side effects than prescription drugs. Always be safe with medicines. Read and follow all instructions on the label.

The medicine that you take may cause side effects. Some side effects may last for a few weeks. Others may last for as long as you take the medicine. Certain pain medicines can cause a bad reaction if you take them with other medicines. Before you start to take pain medicines, be sure to let your doctor know about all of the drugs you take. This includes over-the-counter medicines and complementary treatments (such as herbs).

Over-the-counter drugs to stop headaches

Medicines to stop a headache after it starts include:

  • Acetaminophen.
  • Aspirin.
  • Ibuprofen.
  • Naproxen.
  • Medicine that combines aspirin, acetaminophen, and caffeine.

Talk to your doctor if you are taking medicine more than 2 days a week to stop a headache. Taking too much pain medicine can lead to more headaches. These are called medicine-overuse headaches.

Prescription drugs to prevent headaches

Your doctor may recommend that you take a prescription medicine every day to prevent headaches. You may want to take this medicine if:

  • Over-the-counter medicines don't work to stop your headaches.
  • You take over-the-counter medicines to stop headaches more than 3 times a week.
  • You get a headache more than 15 days a month.

Medicines used to prevent tension headaches include:

  • Antidepressants, such as amitriptyline.
  • Seizure medicines, such as topiramate.
  • Medicines that relax muscles, such as tizanidine.

What non-medicine options are there for treating tension headaches?

Some people find that some non-medicine treatments can help stop a tension headache or prevent one.

If you decide to try one or more of these treatments, make sure that your doctor knows. The doctor may have advice on how to use them safely. Some non-medicine treatments for headaches include:

  • Acupuncture. This involves putting very thin needles into the skin at certain points on the body. Studies show that acupuncture can help prevent tension headaches.
  • Biofeedback. This is a relaxation method to help you learn to control a body function that you normally don't control, such as muscle tension.
  • Cognitive behavioral therapy or problem-solving therapy. Counseling with these methods can help with tension headaches.
  • Meditation. This can produce a state of relaxation that reduces heart rate, slows breathing, and lowers blood pressure.
  • Peppermint oil. It can be rubbed on the forehead and temples. Some people find it helpful.
  • Transcutaneous electrical nerve stimulation (TENS). This treatment uses mild electrical current to treat pain. It may help reduce headache pain.
  • Yoga. Hatha yoga includes meditation and exercises to help you improve flexibility and breathing, decrease stress, and maintain health.

When to Call

Tension headache: When to call

Call 911 anytime you think you may need emergency care. For example, call if:

  • You have signs of a stroke. These may include:
    • Sudden numbness, paralysis, or weakness in your face, arm, or leg, especially on only one side of your body.
    • Sudden vision changes.
    • Sudden trouble speaking.
    • Sudden confusion or trouble understanding simple statements.
    • Sudden problems with walking or balance.
    • A sudden, severe headache that is different from past headaches.

Call your doctor now or seek immediate medical care if:

  • You have a fever and a stiff neck.
  • Your headache gets much worse.

Watch closely for changes in your health, and be sure to contact your doctor if:

  • Your headaches get worse, happen more often, or change in some way.
  • You have new symptoms.
  • Your life is disrupted by your headaches. For example, you often miss work, school, or other activities.
  • You do not get better as expected.


How can you care for yourself when you have tension headaches?

There are things you can do that may help you have fewer headaches—and less pain when you do get them. Some self-care ideas include:

  • Finding and avoiding things that trigger your headaches. Triggers may include stress, hunger, and lack of sleep.
  • Keeping a headache diary to find out what triggers your headaches.
  • Taking over-the-counter medicines to stop a headache.
  • Taking medicine as your doctor advises to stop or prevent a headache.
  • Reducing stress with relaxation and positive-thinking methods.

Copyrighted material adapted with permission from Healthwise, Incorporated. This information does not replace the advice of a doctor.